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A Syllabus 

for 

The Clinical Examination 

of Children. 



EDMUND B. HUEY, Psychologist 

LINCOLN STATE SCHOOL AND COLONY. 

Lincoln, Illinois. 



School Print. 



_. . : ~ ----- 



TMP96-021758 







INTRODUCTORY. 

America is now going seriously about the work of providing 
special classes and schools for defective children, special courts for 
juvenile delinquents, and, in general, special and suitable treat- 
ment for the exceptional child. To do this work effectively a 
systematic examination and record should be made of each case. 
Such record is necessary for the adequate treatmant of the rase 
itself. It furnishes, besides, most valuable data for the research 
psychologist and statistician. 

The forms here presented have been worked out in handling 
the cases here, and are for the most part now in use in this the 
state institution for the feeble-minded. In getting and recording 
this data at least four blanks will ordinarily be used. Photographs 
taken in front and in profile may well be attached to the physical 
examination blank, or may precede the whole clinical record if 
this is made in a single booklet form. With certain supplements 
to be added on the psychological side, the syllabus endeavors to 
provide for a complete account of the child, under the following 
rubrics: 

A. Home Record. 

I. Heredity. 

II. Growth and Retardation. 

III. Medical History. 

IV. Environment and Personal History. 
V. Capacities, Habits, and Character. 

B. Teacher's or Attendant's Record. 
I. Habits and Chacteristics. 

II. Capacities and Incapacities. 

III. Intelligence and Perception. 

IV. Learning, Interests, Imitation, and Memory. 
V. Morals. 

VI. Social Reactions. 

C. Physical Examination. 

I. Anthropometry and Description. 
II. Defects and Deformities. 
III. Medical Examination. 

D. Mental Examination. 

I. Intelligence and Retardation. 



A. 

HOME RECORD. 

(Information to be obtained from parents, family physician, and 
others who know the family well). 

General. 

Child's full name and present address. 

Name and address of parent or guardian. 

Date of birth of child, or, if unknown, apparent age. 

Birthplace of child, of father, of mother. 

Occupation of father and mother. 

Heredity. 





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Standing in 
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Father 




























Mother 




























Father's 
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Father's 
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Mother's 
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Mother's 
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Brother 
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Notes: 

What other relatives of father or mother belong under 6, 8, or 11, 
giving details. 

Which of the above or other blood relatives had any of the follow- 
ing conditions, specifying and giving details: Drug habit, va- 
grancy, special peculiarities of mind or body, hypochondria, sex- 
perversion, defect of sight, hearing, or speech (stating whether 
congenital or acquired), meningitis or brain fever (stating at 
what age) , spasms or convulsions, chorea, hysteria, neurasthenia, 
paralysis, other nervous diseases or conditions, apoplexy, heart 



disease, sudden death, diphtheria, typhoid, scarlet fever, small 
pox, goiter, other severe disease or defect, serious operations, 
confinement in hospitals or institutions (what and why?) miscar- 
riages (number and cause?) cancer, suicide. 
Parents: Father's parents: Mother's parents: 
Brothers, sisters: Other near relatives: 

Growth and Retardation of Child. 

Order of birth. Weight at birth. Born at full term. 
Deficiency or peculiarity at birth. What. 
At what age and how were peculiarities first manifested. 
At what age did the child recognize persons. Sit alone. 
Stand alone. Walk alone. Use spoon. Get first teeth. 
First words. First short sentences. Acquire tidy habits 
Know most of his letters. Get second teeth. Start to school. 
What progress at school. Stopped at what age and grade. Whv 
Reads how. Writes how. Counts to. Adds. 

Multiplies. Divides. Weight. Height. 

Medical History. 

What was the condition of the mother's health or habits during 

gestation. 
Was she mentally troubled. How and why. 

Was labor long and difficult. Instruments used. Anesthetics. 
Did child show deficient animation or vitality at birth. 
Difficulty in breathing or nursing. 
Any indications of specific disease. What. 

Malnutrition in infancy. Rickets. 
What troubles, if an}', in teething. 
Has child had the following, stating age and severity: Meningitis 

or brain fever. Diphtheria. Typhoid fever. 
Scarlet fever. Whooping cough. Measles. 

Chorea or St. Vitus dance. Tuberculosis. Scrofula. 
Sleepwalking. Night terrors. Nervous attacks. Describe. 

Paralysis. Describe. What disease or trouble of eyes? 
Of ears. Of nose and throat. Of skin. 
Has child had epilepsy. Fainting spells or spasms. 

State frequency of convulsions, if any, and date of last. 
What imperfections of speech Of gait and movement. 
What troubles, mental or physical, at puberty? 
At the monthly periods. 

Has the child been pronounced insane or feeble-minded. 
When, and by whom. 

Name any other diseases or affections that child has had. 
Has been in what hospitals or other institutions, and why. 
Has undergone what operations. What severe accidents. 
When was the child last vaccinated. With what result. 



Has the child recently been exposed to infection. State disease 
Give name and address of physician who attended at birth of child. 
Name and address of present family physician. 

Environment and Personal History. 

Has the family always been self-supporting. Cleanly. 

How was .the child treated by and what was the influence of the 

father. 
Of the mother. Of step-parent or others charged with its care. 
Was the child indulged, maltreated, secluded. 
How many persons in the home. How many rooms. 
Was the home tranquil or disturbed. Moral condition of the home. 
What was the influence of child's associates. 
Of associates of the opposite sex. 
What have been the child's chief interests. 
In what ways has child been useful. 
How does the child spend its leisure time. 

Child's deportment and the impression made, at school. At work. 
How long has child worked. At what work and wages. 
How does he care for money or valuables given or earned. 

Capacities, Habits, and Character. 

To what extent, if at all, has the child used alcoholic drinks. 

Tobacco. Cocaine or other drugs. 

What harmful personal habits does he have. 

Does he run away from home. Ever hide or destroy things. 

What is his attitude to animals. To playmates. To parents. 

Is child's memory good. What evidence of it. 

What does he learn rapidly other than school work. 

Does he pay attention well. Obey well. Feed himself. 

Dress and undress. Tie a shoe lace. Have morbid fears. 

Queer ideas; specify. Is child attentive to calls of nature. 

Does he sleep well. How many hours. 

Underscore words that describe child: Trustworthy, industrious, 
untruthful, lazy, seclusive, moody, cheerful, sly, selfish, slovenly, 
neat, ill-tempered, violent, excitable, thieving, sissy or cry-baby, 
emotional, affectionate, unfeeling, fighter, fits of temper, obsti- 
nate, anxious, fearful, complaining, gossipy, laugh or cry with- 
out cause, very changeable, proud (of what), resentful. 

What cause has been assigned for deficiency, if any is present. 

Of what delinquencies has child been guilty. Give details. 

What other exceptional behavior has been noted. 

What punishments have been inflicted. 

What is child's attitude toward correction. 

What efforts have been made to help child, when, and by whom. 



B. 

TEACHER'S OR ATTENDANT'S RECORD. 

(The child should be under observation for at least a month before 
this blank is filled.) 

Observation data concerning- the habits, capacities, and mentality 
of Reported by Date 

Habits and Characteristics. 

Is the child very nervous. When, and how shown. 

Is he noisy. Mischievous. How. 

Does he run or stray away. Often. Get lost. When. 

Can he see well. Hear well. Read outside of school work. What. 

Does he wet day clothing. Soil day clothing. 

What unfortunate habits, sexual or otherwise. 

Does he complain much. Of what. 

In what way is the child most troublesome or fault}'. 

In what ways does he most differ, if at all, from normal children. 

Describe his habitual position in study or recitation. 

(Underline below the words that correctly describe the child.) 
Cheerful. Morose. Quarrelsome. Active. Obstinate. Sensi- 
tive. Moody. Good-tempered. Excitable. Changeable in 
mood or character. Sly. Resentful. Lazy. Slovenly. Neat. 
Cleanly. Proud. Of what. Silent. Talkative. Obedient. 

Generally destructive. Heedless of danger. Destroys clothing. 
Destroys furniture. Cry without cause. Laugh without cause. 
Mouth usually open. Emotional. Lacking in feeling. Anxious. 
Impulsive. Lack self-control. Easily managed. Superstitious? 
Apprehensive or fearful. Fears what. Cranky. Humorous. 
Very stupid. Selfish. Generous. Gossipy. 

Capacities and Incapacities. 

Does he help care for other children. 

Need careful and close supervision. 

Can he talk. Much. Distinctly. Can he do errands. 



Does he know 


some letters. 


How many objects can he count 


Can he add. 


Multiply. 


Divide. 


Reads how, in 


Reader. 


Understands what he reads. 


well. 


well. 




Writes fairly. 


Spells fairly. 


Copies dictation how. 


badly. 


badly. 




well . 


well, 




Draws fairly. 


Plavs fairly, 


on what musical instrument. 


badly. 


badly, 





well. 
Sings fairly. What kind of songs or music. 

badly. 
What and how well can child do in manual or industrial work. 
In kindergarten. In gymnastics. In athletics generally. 
In entertainment work. Details. 
What other studies or work is he engaged in, and what progress in 

each. 
In what does he do his best work. His poorest. 
What is he "good at" in any direction. 

Are there times when he does much better or worse than usual. 
How account for these variations. What prevents his doing better. 
What noticeable defects has he. 

Intelligence and Perception. 

Can he tie an ordinary knot. Understand and obey commands. 
Tell time. Take care of apparatus and furniture. 
How complicated machines or tools can he use. 
How well adapt himself to changed schedule or other new conditions. 
Does he think of what to do in emergencies, or in play. Examples. 
What other evidences of intelligence or stupidity. 
Ever imagine that he sees things. That he hears voices or other 
sounds. 

Movements and Play. 

Can he throw and catch a ball. Dance. How well. 
How does he walk. Is he very awkward . Very active. 
Left-handed. Use both hands equally well. Quick or slow. 
What automatic movements or mannerisms has he, and when. 
How does he go up and down stairs. 

Play much, or at all. How. How long at one thing. 
What, for example. Does he build blocks. Collect things. 
Excel or lead others in play. Play over past experiences. 
"Make believe" much in play. Play alone or with others, usually. 

Learning, Interests, Imitation, and Memory. 

Name the main interests noticed in this child, underlining the 

strongest. 
Does he learn new work easily. Remember it well. 
Learn "pieces" easily. Remember them well. 
Talk or seem to think much of old-time experiences. 
Of recent experiences. Is he very forgetful. 
What does he imitate. How much and how well. 
Mechanically or with understanding. 
How much progress or decline have you seen in him, in how long. 



Does he stick to tasks well. Willing and tries. 

Is he easily confused. When and how. 

Do you think he will improve, stand still, or go back. 

Morals. 

Is he cruel. Profane. Obscene. Deceitful. Thieving. 

Untruthful. Lacking in shame or modesty. 

Ever violent to others. Show sense of duty. 

Of right and wrong, or remorse. 

What evidences of interest in religion. Is he trustworthy. 

Of what immoral acts is the child frequently or sometimes guilty. 

Other Social Reactions. 

Is the child easily led or persuaded. By whom. 

Over-dependent on others. Like to have and show authority. 

Is he confiding. Chummy. Timid. 

Bashful. Affectionate. Sociable. Sympathetic. 

What is his attitude toward his parents. 

Toward his brothers or sisters. Toward strangers. 

Toward animals or pets. Does he get on well with other children. 

Why not. Is he a sissy or cry-baby. 



PHYSICAL EXAMINATION. 

Anthropometry and Description. 

Weight. Height standing. Height sitting. 
Chest girth at inspiration. At expiration- 
Head circumference. Length. Breadth. 

Height above auditory meatus. Hair. Eyes. Complexion. 
Teeth. Scars. 

Defects and Deformities. 

(Underscore those found, in list below, and add any others. ) 

Head: Microcephalic, macrocephalic, hydrocephalic, asymmetrical. 

Face: Prognathous, immobile, inferior maxillary small, large, 
superior maxillary small, nasal bones sunken, forehead re- 
treating, narrow; face asymmetrical as to forehead, nose, 
eyes, ears, mouth. 

Nose: Much deflected, septum abnormal, base of nose broad, 
nostrils open forward. 

Lips: Hare-lip, lips very thick, very thin, fissured above, below, 
very long, very short. 

Teeth: Hutchinson's, persisting milk teeth, serrated, pointed or 



notched, chalky, impacted, irregular in shape or arrange- 
ment, decayed, rachitic. 

Soft Palate: Twisted R. L. Response of azygos muscle. 

Hard Palate: Cleft, V-shaped, semi- V-shaped, saddle-shaped, 
high, narrow. 

Eyes: Pupil irregular or eccentric, congenital ptosis, epicanthus, 
oblique mongolian, palpebral fissure small, cross-eye; asym- 
metry in size, in color. 

Kars: Very large, very small, Darwiniantubercle, abnormal de- 
velopment, asymmetrical position or formation. 

Tongue: Very large, ver> r small, thick, flat, pointed, fissured, 
enlarged papillae. 

Thyroid: Enlarged, atrophied, absent. 

Thorax: Breasts absent, atrophied, small, large, supernumerary; de- 
velopment of breasts in male; pigeon breast, funnel breast. 

Upper Limbs: Very long, very short, asymmetrical; malformation 
of right, left hand; fingers united, supernumerary, two- 
jointed, very long, very short. Little fingers imperfect. 
Left handed, ambidextrous. 

Lower Limbs: Club foot; toes united, supernumerary; knock- 
knee, bow-legs, legs or feet very long, very short, 
asymmetrical. 

Genitals: Incomplete descent of one or both testicles. Organs 
over-developed, undeveloped, atrophied. Hermaphrodism, 
true or false. Phimosis. Stenosis or reduplication of 
vaginal and uterine canals. Undeveloped uterus, ovaries, 
vagina. Clitoris enlarged or hooded. 

Skin: Pallid, sallow, leathery, prematurely wrinkled, birth-marks. 

Hair: Coarse; scanty on face, eye brows, chest, pubes. Hairy 
moles or tufts on body. Gray hair in patches. Bald 
spots. Eye brows meet. Abnormal distribution of hair. 

Nails: Thin and friable, pigmented, arched and thickened, long, 
short, furrowed lengthwise, crosswise. 

Nutrition: Anaemia. Obesity. 

Vaso-motor: Flushing, local heat or cold, excessive or local 
sweating, factitious urticaria. 

Bodily Characteristics: Gigantism, dwarfism. General balance 
relaxed. Asymmetrical posture or head balance. Scoliosis, 
lordosis. Feminine aspect. Mincing or shuffling gait. 

Medical Examination. 

1. Neuro-muscular System: 

(a) Reflexes: Knee jerk. Achilles. Pupillary. Conjunctival. 

Plantar. Ankle clonus. Cremasteric. Abdominal. Arm. 

Jaw. Palatal. Pharyngeal. Defecation. Micturition. 
(Examine others where indicated.) 



(h) Electrical responses. 

(c) Cranial nerves: II. Visual field. Optic discs. 

III. IV. VI. Strabismus. Ocular movements. Nystagmus. 
Ptosis. Diplopia. V. (motor, sensory.) VII (paralysis, tics.) 
IX, X, XI, XII. 

(d) Vertebral column: (deviations, etc.) 

(c) Sensation: Vision R. L. Hearing R. L. Smell R. I,. 
Taste. Pressure. Temperature. Pain. Muscular. 
Stereoagnosis. Anaesthesias, hyperesthesias, paresthesias, 
especially asymmetrical or local variations. Headache. Vertigo. 

(f) Motor: Tonicity. Strength. Co-ordination or ataxia. 
Tremors (coarse, fine, unilateral, intentional, spastic, ataxic, 
intermittent, jerky, uudulatorv.) Paralysis. Contractures. 
Tics. 

Spasms (general, unilateral, local, tonic, clonic, purposive.) 

(g) Other nerve signs. 

(h) Speech: Stammering, stuttering, lisping, defective articula- 
tion, semi -mutism, mutism, 
(i) Writing: (j) Mimic and gesture: (k) Gait. 

2. Ej'e, ear, nose, and throat: 

3. Skin, mucous membrane, trophic disorders: 

4. Circulation: Heart. Pulse. Temperature. Blood pressure. 

Veins. Arteries. Blood. Vasomotor. 

5. Respiration: Rate. Character. Chest inspection. 

6. Alimentation: Stomach. Intestines and abdomen. Breath. 

Tongue. Appetite. Digestion. 

7. Liver, spleen and pancreas. 

8. Other glands (tonsils, adenoid vegetations, cervical, sub- 

maxillary, axillary, inguinal, thyroid.) 

9. Genito-urinary system: Reproductive activities and mis- 

fit uctionings. 

10. Laboratory examination of sputum, blood, urine, etc. 

11. Habits: (Sleep, drugs, beverages, tobacco, uucleauliness.) 

12. Infections, vermin, vaccination. 

D. 

MENTAL EX A MI N ATION . 
Intelugknce axd Retardation. The Binet Scat,!:. 

Mental examination of Age Examined by 

Grade Passed tests of expected at this age. Accord- 
ing to these tests, child's intelligence is approximately at the level 

of years of age, indicating a retardation of years. Syllabus 

used Conditions. 

Mentality of one and two years. 

1. Eye follows light 

2. Block is grasped and handled, when placed in hand. 

9 



3. Suspended spool is grasped when seen. 

4. Candy is chosen instead of block. 

5. Paper is removed from candy before eating, child having 

seen the wrapping. 

6. Child obeys simple commands, and imitates simple movements. 

Mentality of three years. 

1. Touches nose, eyes, mouth, and pictures of these, as directed. 

2. Repeats easy sentences of six syllables, with no error. 

3. Repeats two numerals. 

4. Enumerates familiar objects in pictures. 

5. Gives family name. 

Mentality of four years. 

6. Knows own sex. 

7. Names key, penny, knife. 

8. Repeats three numerals in order, when heard once. 

9. Tells which is longer of lines differing by a centimeter. 

Mentality of five years. 

10. Discriminates weights of 3 and 12 grams, 6 and 15 grams. 

11. Draws, after copy, a square that can be recognized as such. 

12. Rearranges a rectangular card that has been cut diagonally 

into two triangles. 

13. Counts four pennies. 

Mentality of six years. 

14. Shows right hand, left ear. 

15. Repeats easy sentences of 16 syllables. 

16. Distinguishes pretty from distinctly ugly or deformed faces, 

in pictures. 

17. Defines, in terms of use, the words fork, table, chair, horse, 

mama, three satisfactorily. 

18. Performs three commissions given simultaneously. 

19. Knows own age. 

20. Knows whether it is forenoon or afternoon. 

Mentality of seven years. 

21. Notes omission of eyes, nose, mouth, or arms, from as many 

portraits. 

22. States number of fingers on right hand, left hand, both 

hands, without counting. 

23. Copies written phrase, with pen, so that it can be read. 

24. Draws diamond shape, from copy, so that it can be recognized. 

25. Repeats five numerals in order, when pronounced once at 

half second intervals. 

26. Describes pictures shown in No. 4. 

27. Counts thirteen pennies. 

28. Names penny, nickel, dime, and silver dollar. 

Mentality of eight years. 

29. Reproduces correctly two facts, after once reading seven lines 

about a fire. 

10 



30. Counts values of six stamps, three ones and three twos, in 

less than fifteen seconds. 

31. Names red, green, blue, yellow. 

32. Counts from 20 to in twenty seconds with not more than 

one error. 

33. Copies easy dictation, so that it can be read. 

34. States difference between paper and cloth, butterfly and fly, 

wood and glass, in two minutes, two satisfactorily. 
Mentality of nine years. 

35. Names the day and date, allowing error of three days either 

way on day of month. 

36. Names days of week in order, in ten seconds. 

37. Gives correct change from a quarter paid for an article costing 

four cents. 

38. Defines in terms superior to statements of use, in No. 17. 

39. Reproduces six facts from seven lines read once, in No. 29. 

40. Arranges, in order of weight, boxes of same size and appear- 

ance weighing 6, 9, 12, 15, and 18 grams, in three minutes. 
Two out of three trials. 

Mentality of ten years. 

41. Names the months in order, allowing one omission or in- 

version, in fifteen seconds. 

42. Names a penny, nickel, dime, quarter, half, dollar, two, five, 

and ten dollar bills, in forty seconds. 

43. Uses three given words in not more than two sentences. 

44. Tells what one should do if misses train, if unintentionally 

struck by playmate, or if breaks an object belonging to 
others. Two satisfactorily. 

45. Tells what would do if late for school, or before undertaking 

an important affair, aud why we should judge by acts rather 
than by words. (Two other questions may be asked.) 
Mentality of eleven years. 

46. Detects incongruities in three out of five statements, in about 

two minutes. 
Uses three given words in one sentence. 
Names at least sixty words in three minutes. 
Defines charity, justice, goodness, two satisfactorily. 
Rearranges shuffled words of eight- word sentences, two out 

of three, w T ith one minute for each. 

Mentality of twelve years. 

51. Repeats seven numerals in order, when heard once. 

52. Names three words that rhyme with obey, in one minute. 

53. Repeats, with no error, sentence of twenty-six syllables. 

54. Infers a fact from given circumstances which indicate the fact. 

Mentality of thirteen years. 

55. Images and draws result of cutting triangle from side of 

twice folded paper. 

11 



56. Images and draws new form produced by joining transposed 

pieces of diagonally divided visiting card. 

57. Distinguishes between abstract terms of similar sound or 

meaning. 

The above scale is probably the best means yet devised for de- 
termining the fact and measuring the amount of mental retarda- 
tion. Revisions and additions will doubtless be needed. These 
tests represent the given ages only when the tests are applied ac- 
cording to the directions given by Binet and Simon in L/Anne 
Psychologique for 1908. I shall print a syllabus to guide in giv- 
ing these tests in an early, probably the June number of the Journal 
of Educational Psychology. A full account of them has been given 
by Dr. H. H. Goddard in The Training School for January, 1910. 
The circumstances of printing this syllabus have made it impossible 
to give full directions here. 

After each number, a plus sign means passed, minus means 
failed, exclamation point means absurd response, A means atten- 
tion wanting, T means timidity, R means resistance, I means 
ignorance, fraction means partial credit (rarely used). In making 
the count the child is credited with the level at which he passes all 
the tests, or all but one. To this is added one year for each five 
tests passed at higher levels. We record also the total number of 
tests passed, with the number that should be passed at the child's 
age. Half years may be used, for instance the child's age may 
be 10 1-2 and his mental level 8 1-2. 

The tests for one and two years, numbered separately, are ar- 
ranged in order of difficulty, and represent successive stages of 
mentality from the first month to two years. In the Binet scheme 
retarded children who cannot pass beyond the tests for two years 
are classed as idiots. -Above this but below the eight year level 
they are imbeciles. Children passing the tests for eight years or 
higher are classed as feeble-minded. The terms "backward" (or 
"retarded") and "unstable" may be used for the two main transi- 
tion classes between feeble-mindedness and normality. 

The intelligence is of course not the whole mind, and retarda- 
tion is not the whole of abnormality. A complete mental exami- 
nation, in the schema which I am working out here, will involve 
tests and observations upon sensory discrimination; perception- 
conception; ideation-imagination; orientation in space and time; 
association; learning and memory; feelings, interests, instincts; 
temperament and attitude; movement, imitation, suggestion, and 
automatism; intelligence and reason; play; attention, effort, will; 
mental span and synthesis; mal-adaptations and emotivity; ideals 
and values; self and social reactions. We are yet far from having 
standard tests and norms for all these functions. But intelligence 
is a function of all of them, and its measurement is our most repre- 
sentative single means of gauging mind. 

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L'ERfiSX 0F CONGRESS 



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